Mental Capacity Act 2005: a practice-based course Supporting older people in care homes and the community as they would like. Session Three Planning in advance. Revision!. 5 key principles 2 stage test of capacity 4 stage assessment of capacity
Planning in advance
5 key principles
2 stage test of capacity
4 stage assessment of capacity
5 stage summary of ‘best interests’ criteria.
…can help promote for residents
A sense of being in control
A feeling of confidence, knowing you will try to avoid undignified situations
Advance Care Planning
Lasting Power of Attorney
Taken from ‘Advance Care Planning: A guide for Health and Social Care Staff’, NHS End of Life Care Programme, February 2007
“ACP is a process of discussion between an individual and their care providers irrespective of discipline. If the individual wishes, their family and friends may be included.
With the individual’s agreement, this discussion should be documented, regularly reviewed, and communicated to key persons involved in their care….”
Statement of wishes and preferences
No legal status, not legally binding, but guidance and preferences
If person lacks capacity to make a decision about health and welfare, then an advance statement will be taken into account when decisions are being made.
Helps to inform ‘best interests’ for a person.
An example is the Preferred Priorities of Care form
Relates to an advance decision to refuse treatment
Legally binding, if valid and applicable
Must be in writing if it relates to refusal of life- sustaining treatment, signed & witnessed
Must state clearly that if it still applies even if life is at risk
Person must have mental capacity at the time of writing
Validity and Applicability
Must relate to treatment being considered
Must relate to exact circumstances
Questions to consider
Has the person done anything that clearly goes against their advance decision?
Has the person withdrawn their decision?
Has an LPA been set up after advance decision?
Would the person have changed their decision if they had known more about current circumstances?
Taken from Mental Capacity Act Code of Practice
Old fashioned terms
Not clear as to meaning
Usually accepted to be an advance refusal of treatment, but not necessarily so
Is simply a legal entity giving certain powers to another person
LPA only operates when a person has LOST capacity
Differs from an Enduring Power of Attorney
Must be registered with the Office of the Public Guardian (OPG)
Now 2 types of LPA
PWLPA can make decisions about health and welfare
PWLPA can make decisions about life-sustaining treatments
Can be complicated to set up – but all documents on the web
What do you think are the advantages of PWLPAs?
What do you think are the potential problems?
What actions do you need to take if a visitor or relative says they have a PWLPA for a resident?
If no “Named persons”, then donor must appoint 2 Certificate Providers
Attorneys must act in best interests
Person setting up the LPA can limit the power of the Attorney
Objections can be raised by anyone with a legitimate interest in the LPA
Replaces Enduring Powers of Attorney
LPAs now cover Health & Personal Welfare
Can ONLY be used if the LPA Donor has LOST capacity
Clear to all who can decide on person’s behalf
Significant and valuable safeguards built in to LPAs
CQC can ask you if you are aware of any LPAs with your residents or clients in the community.
The process of planning in advance can enable people to think about, discuss and have their wishes recorded
A written advance care plan is only to be referred to if/when a person lacks the capacity to make a decision about their care and treatment
A person who has a Lasting Power of Attorney for health & welfare can make decisions for a person if they are unable to.